Beth - Week 4 - Exam 2 Flashcards
(79 cards)
1
Q
what is a brain tumor?
A
an abnormal growth of tissue in the brain or central spine
2
Q
tumors are referred based on what?
A
- where tumor cells originated
- cancerous (malignant or non-meaning benign)
3
Q
what are the characteristics of a benign tumor?
A
- least aggressive
- Originate from cells within or surrounding the brain
- Do not contain cancer cells
- Grow slowly, and typically have clear borders that
do not spread into other tissue
4
Q
what is a malignant tumor?
A
tumors contain cancer cells and often do
not have clear borders
5
Q
what are the characteristics of a malignant tumor?
A
- Life threatening because
- Grow rapidly
- Invade surrounding brain tissue
6
Q
what is primary tumor?
A
starts in the brain
7
Q
what is a metastatic tumor?
A
secondary brain tumors
8
Q
which cancers metastasize to the brain?
A
breast cancer and lung cancer
9
Q
what are the 6 different types of brain tumors?
A
gliomas primary CNS lymphomas meningioma acoustic neuroma pituitary adenoma hemangioblastoma
10
Q
where do gliomas occur?
A
they infiltrate the brain (glioblasts)
11
Q
where do primary CNS lymphomas occur?
A
lymphocytes
12
Q
where do meningiomas occur?
A
they cover the brain tissue (meninges)
13
Q
where do acoustic neuromas occur?
A
covering of any C.N.
- hard to find
14
Q
where do the pituitary adenomas occur?
A
neoplasm of a gland
15
Q
where do hemangioblastomas occur?
A
blood vessels
16
Q
what are the grading scale for brain tumors?
A
grade I - well differentiated grade II - moderately differentiated (better outcome) grade III - poorly differentiated grade IV - unable to differentiate ** III and IV - 3 - 6 mo to live
17
Q
what do gliomas affect?
A
affects the tissue that forms the cells and fibers of brain
18
Q
gliomas: what grades are considered malignant and benign?
A
grade 1/2: benign
grade 3/4: malignant
19
Q
what is a specific type of glioma?
A
astrocytoma
20
Q
TEST: what are the characteristics of astrocytomas?
A
common/aggressive/malignant
- fast growing “fingers” or “star”
21
Q
what glioma is the WORST?
A
glioblastoma multiforme
22
Q
meningiomas are common in what group?
A
middle age, female, adults
23
Q
how to meningiomas present?
A
encapsulated; compression rather than invasion
24
Q
where do meningiomas present?
A
any part of brain from deep ventricles to the skull base
25
T/F: meningiomas are usually malignant
FALSE - they are usually benign
26
what are clinical manifestations of meningiomas?
* INCREASED ICP *
- severe HA
- change in vision
- hemiparesis
27
what C.N does acoustic neuromas affect?
C.N VIII (acoustic)
28
what are the two characteristics of acoustic neuromas?
- slow growing
| - benign
29
what population should we be aware of when it comes to acoustic neuromas?
> 50 y/o males
- can't hear well
- should check out everything
30
what are the clinical manifestations of acoustic neuromas?
- hearing loss
- tinnitus
- vertigo
31
who is at risk for a hemagioblastoma?
persons < 40 y/o w/ hemorrhage
32
those with a hemagioblastoma are at risk for what?
risk for CVA
33
what are the characteristics of pituitary adenomas?
- usually benign, small, encapsulated, and slow growing
34
what population are pituitary adenomas at a higher risk for?
higher risk in women of child bearing ye`ars
35
the symptoms of pituitary adenoma are _________?
symptoms of pituitary hormonal dysfunction
| - tell tale signs: change in ability to smell
36
primary CNS lymphomas are higher with what types of patients?
* *higher with transplant recipients**
- immunodeficiency syndrome
- AIDS patients
37
what are characteristics of primary CNS lymphomas?
- Symptoms of lump or mass within the brain
- It is nearly always due to diffuse large B-cell lymphoma (DLBCL), a type of high-grade nonHodgkin
lymphoma
38
what are the main assessment finding for someone with a brain tumor?
- Personality changes
- Confusion
- Vision changes
- HEADACHE (severity/pathway/different than normal ones; same tx doesn't work)
- SEIZURES
- VOMITING/NAUSEA
39
what are other assessment findings for someone with a brain tumor?
- CSF obstruction -- hydrocephalus (IICP)
- Papilledema
- Altered Sensorium
- Motor abnormalities - weakness; paralysis
- Sensory Abnormalities - depends on where the tumor is located
40
T/F assessment can be specific to the lobe of the tumor location
TRUE
41
where are the most obvious location findings?
```
FRONTAL (behavior)
TEMPORAL (aphasia)
PARIETAL (loss of memory)
CEREBELLUM (balance)
OCCIPITAL (vision)
```
42
`what are the least obvious location findings?
```
Subcortical
Meningeal
Metastatic
Thalamus
Sellar (pituitary)
Fourth Ventricle
Cerebellopontine
Brain stem
```
43
what does the frontal lobe control?
judgement, foresight, voluntary movement
44
what does the motor cortex control?
movement
45
what does broca's area control?
speech
46
what does temporal lobe control?
intellectual and emotional functions
47
what does brainstem control?
swallowing, breathing, heartbeat, wakefulness center, and other involuntary functions
48
what does cerebellum control?
coordination
49
what does wernicke's area control?
speech comprehension
50
what does occipital control?
visual
51
what does the temporal lobe control?
hearing
52
what does the parietal lobe control?
comprehension of language
53
what does the sensory cortex control?
pain, heath, and other sensations.
54
what are the diagnostics of a brain tumor?
```
CT - rapid
MRI (MRA & MRV) - gold standard
PET
Stereotactic craniotomy - very precise; don't destroy good tissue
Biopsy
LP-CSF
EEG (seizures → tx)
Blood tests (HIV)
Bone Marrow
```
55
what is the medical management for brain tumors ?
- radiation (stereotactic - aimed at tumor)
- chemotherapy (IV and the BBB; Intrathetcal; Intraventricular - ommaya reservoir)
- steroids
- combination
- IV autologous bone marrow
56
what are the surgical management for brain tumors?
removal of all
removal of part
shunts
57
what surgeries are used for management of brain tumors?
```
Craniotomy (any opening)
Craniectomy (Bone flap)
Cranioplasty
Burr Holes (For Subdural Hematoma)
Radio-isotope Implants
Stereotactic
Transphenoidal Hypophesectomy
```
58
what are the NIs for a patient who had a craniotomy?
* Assess for changes in LOC
* HOB 30 degrees
* Keep dressing in place to reduce edema and swelling
* Treat headache/nausea
* Assess drainage, bleeding and odor
59
what is the post op assessment, care and
| concerns following Crani Surgery?
```
- NEURO STATUS
´Baseline
´When can they take fluids?
- HEMORRHAGE and SWELLING
´Steroids (usually w/ tumor resection)
```
60
what are the characteristics of Diabetes Insipidus?
- No secretion of ADH
- U/O HIGH (>300-400cc/hr)
- sp. gr. < 1.005
- dehydrated
61
what are the priorities with DI?
Assess electrolyte imbalance
| Intake verse output
62
what are the nursing interventions for DI?
- fluid replacement Drink to Thirst
- DDAVP (desmopressin acetate)
- Assess for SIADH
- WATER INTOXICATION
63
what are the characteristics of Syndrome of Inappropriate Anti-Diuretic Hormone?
- Intake verses output
- too much ADH
- water retention
- U/O < 20 cc/hr
- sp. gr. > 1.025
64
what are the priorities for SIADH?
assess electrolyte imbalance (Na+)
65
what are the NI for SIADH?
- fluid restriction
- diuretics
- frequently assess lytes
- assess s/sx dehydration or overload
- specific gravity = #1 test
66
what is the post-op care for meningitis following crani surgery?
- Prophylactic antibiotics (have to cross BBB)
| - Drain and incision sites—assess
67
what is the post-op care for respiratory problems following crani surgery?
- Emergency equipment? (have suction)
- Suction when necessary
- Don't encourage coughing
- DO encourage deep breathing and use I.S.
68
what is the post op care for seizures following crani surgery?
- Anticonvulsants (maybe)
- sometimes prophylactically
- protect airway, call MD, have them ask what we saw/decide
69
what is the post op care for CSF leak following a crani surgery?
- Call MD (where is the leak?) - call if wet dressing (clear)
- Glucose present?
- Assess drsg and wound if drsg removed
70
what is the post op care for IICP following a crani surgery?
- Proper positioning
- What if there is a drain? → right side? looks like IVPB bag by shoulder dependent
- What if surgery in posterior fossa?
- Don"t restrain—get an order if needed → don't pull out drain
- Don"t give enemas → ↑ ICP
71
what is the post op care for N+V following crani surgery?
antiemetics
72
what is the post op care for pain/HA following crani surgery?
analgesics - codeine
73
what is the post op care for psychosocial impact following crani surgery?
shaved head
peri-orbital edema (HOB at 30; ice in gloves)
ecchymosis of the face
will the pt die or ever be the same? be honest - i really don't know → sounds like you have some ?s for the MD, I'll make sure he comes in
74
what are the assessments and post op care for a trans sphenoidal approach after surgery?
Nasal congestion
Nausea
Headache
75
what are the assessments and post op care for a trans sphenoidal approach day after surgery?
hormone-replacement medications may be given
| **MRI of the brain obtained 1 to 2 days
76
what ispost op care for a trans sphenoidal approach?
´ Peri-orbital ecchymosis/ Facial edema
´ HOB elevated
´ Visual field loss or deterioration @ assess → call MD risk for damage to CN 3; know baseline vision
´ Urine Output? Assess for DI
77
TEST: what are the nursing care considerations for surgery?
- pain control
- frequent assessment (report change in LOC; ALWAYS think about ABCs → pts headed toward coma can't support their airway
- family at bedside
- ROM passive q 2-3 hrs
- HOB 30
- I + O
- emotional support (possible referral to LCSW)
78
TEST: what are the trans-sphenoidal patient education post-op?
- Avoid blowing your nose, coughing, sneezing
- Avoid drinking with a straw
- Avoid bending over/straining onthe toilet for 4 weeks (stool softener)
- Do not drive for 2 weeks after surgery unless instructed otherwise
79
During the assessment of a patient who has a tumor of the left frontal lobe, the nurse would expect to find:
personality and judgement changes
